Why Colorectal Cancer Is Caught So Late in Zimbabwe: Patients and Families Map the Roadblocks

Colorectal cancer has been quietly rising in Zimbabwe for the past three decades, and by the time most patients finally receive a diagnosis, the disease has already reached an advanced stage. A new qualitative study, published in BMC Cancer, has now traced the full journey that patients and their families take from the first whisper of symptoms to a confirmed diagnosis, and the picture it paints is one of long delays, financial strain and fragmented services, punctuated by moments of remarkable resilience and support. The findings offer one of the most detailed accounts yet of how cancer diagnosis actually unfolds on the ground in sub-Saharan Africa, where the majority of patients still arrive at hospital with disease that has already spread.

The research team, led by Simbarashe Chinyowa of the University of Zimbabwe together with colleagues at the University of Cape Town and the University of California San Francisco, interviewed thirteen recently diagnosed colorectal cancer patients and thirteen of their caregivers. The participants were recruited consecutively from five major hospital sites across the country, including Parirenyatwa Group of Hospitals and Sally Mugabe Central Hospital in Harare, Chitungwiza Central Hospital, and Mpilo Hospital and the United Bulawayo Hospitals in Bulawayo. All of the patients were symptomatic and had been admitted either electively or as emergencies for colorectal surgery. Crucially, the study included four patient-caregiver dyads, allowing the researchers to compare how the same diagnostic journey was experienced by both the person with cancer and the family member supporting them.

The interviews were audio-recorded, transcribed and translated into English, then analysed using inductive coding guided by the Model of Pathways to Treatment, a well-established framework that divides the diagnostic journey into distinct intervals: the time before a patient recognises something is wrong, the time before they seek help, and the time between first presenting to the health system and receiving a definitive diagnosis. This structure allowed the team to pinpoint exactly where in the journey delays occur and what factors either accelerate or obstruct progress at each stage. Ethical approval was granted by the Joint Research Ethics Committee for the University of Zimbabwe Faculty of Health Sciences and Parirenyatwa Group of Hospitals and by the Medical Research Council of Zimbabwe, and all participants gave written and verbal consent.

The first interval, known as the appraisal interval, turned out to be shaped by powerful psychological and cultural forces. Many patients normalised their symptoms, interpreting rectal bleeding, changes in bowel habits or abdominal discomfort as ordinary complaints that did not warrant medical attention. A widespread belief in the body’s capacity to heal itself encouraged a wait-and-see approach, while some participants described a perceived futility of treatment, a fatalism that suggested even a diagnosis would change little. These beliefs kept people away from clinics during the critical early window when colorectal cancer is most treatable. The researchers found that this phase of the journey, before any contact with the health system, could consume enormous amounts of time, silently allowing tumours to progress.

What finally pushed patients to seek help was often the arrival of alarming symptoms that could no longer be ignored, or the persistence and worsening of symptoms over time. Social networks also played a decisive role: family members, friends and neighbours who noticed something wrong and urged the patient to visit a health facility frequently tipped the balance toward action. This finding underscores a recurring theme in the study, namely that in the Zimbabwean context the diagnostic journey is rarely a solo undertaking. It is a family project, shaped by collective decision-making, shared resources and, in many cases, the appointment of a designated caregiver who accompanied the patient through every stage of care.

Once patients decided to seek help, a second set of obstacles emerged. The most prominent were financial: many participants simply lacked the money to pay for consultations, transport, investigations or the medications needed along the diagnostic pathway. Logistical barriers compounded the problem, particularly when the nearest facility offering colorectal services was far from home. The study notes that these burdens were amplified by distance, meaning that patients in rural or remote areas faced a double disadvantage of higher travel costs and longer journeys. In a health system where patients frequently must fund much of their own care out of pocket, the ability to reach a hospital and pay for a colonoscopy can be the difference between early detection and a late-stage emergency admission.

Family support emerged as the single most important facilitator during this help-seeking interval. When relatives could contribute money, provide transport or accompany the patient to appointments, the journey moved forward. The designation of a caregiver who acted as a chaperone during all health-related visits proved especially valuable, ensuring that patients who were unwell, unfamiliar with the system or unable to advocate for themselves still made it to the right place at the right time. The researchers argue that this caregiving role is an underappreciated asset in cancer control, one that health systems could deliberately support rather than leave to chance.

The third phase, the diagnostic interval between first presentation and confirmed diagnosis, revealed systemic weaknesses inside the health facilities themselves. Services for colorectal cancer are heavily centralised in a handful of hospitals, forcing patients to travel long distances for specialist assessment and endoscopy. High costs persisted at this stage as well, and inefficient consultation scheduling meant that appointments were delayed or lost. Misdiagnoses added further delay, with some patients initially treated for other conditions before the cancer was recognised. Each of these barriers added weeks or months to a journey that had often already stretched over a year, pushing patients closer to the advanced presentations that dominate colorectal cancer care in the region.

Yet the study also documents what good care looks like when the system functions. Participants reported positive experiences when there was strong rapport between patient and doctor, when healthcare workers were knowledgeable about colorectal cancer, and when clear referral prompts and pathways were provided. Notably, social welfare department support proved vital to the successful diagnosis of several participants, helping to cover costs that would otherwise have halted the journey entirely. These facilitators, the authors suggest, are not expensive to replicate: training frontline clinicians to recognise red-flag symptoms, streamlining referral pathways and strengthening social welfare mechanisms could all shorten the diagnostic interval substantially.

The study’s conclusions point in two directions at once. From a public health education perspective, the findings argue for campaigns that counter symptom normalisation and the belief in body self-healing, teaching communities that rectal bleeding and persistent bowel changes demand medical attention. From a health system policy perspective, they call for decentralising diagnostic services, reducing costs, improving scheduling and building formal support for the caregivers who already carry so much of the load. With colorectal cancer incidence climbing steadily in Zimbabwe and across sub-Saharan Africa, and with most patients still diagnosed too late for curative treatment, the voices of these twenty-six patients and caregivers provide a rare and valuable roadmap, showing precisely where the journey to diagnosis breaks down and, just as importantly, what keeps it moving.

Subject of Research: Barriers and facilitators to timely colorectal cancer diagnosis in Zimbabwe

Article Title: Barriers and facilitators to colorectal cancer diagnosis in Zimbabwe: a qualitative study

Article References: Chinyowa, S., Chitukuta, M., Katsidzira, L., Chirenje, M. Z., Muguti, G., & Moodley, J. (2026). Barriers and facilitators to colorectal cancer diagnosis in Zimbabwe: a qualitative study. BMC Cancer. https://doi.org/10.1186/s12885-026-17064-1

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17064-1

Keywords: colorectal cancer, Zimbabwe, cancer diagnosis, qualitative research, caregivers, health systems, sub-Saharan Africa, patient pathways, diagnostic delay, health communication, cancer screening, social welfare